Individual
MR. ROBERT WILLIAM PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(480) 688-6930
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1287
ID
363A00000X
Physician Assistant
2551
AZ
363A00000X
Physician Assistant
Primary
PA-1287
ID
Other
Enumeration date
11/16/2006
Last updated
04/12/2023
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